About this Presentation
Patient falls remain a leading source of harm in hospitals. In this presentation, Dr. Bahadir Inozu shares findings from a three-month initiative at Ankara Etlik City Hospital, where Constraints Management and High Reliability Organization principles were used to dramatically reduce fall rates. Using TOC’s Five Focusing Steps, the hospital identified systemic bottlenecks and implemented high-leverage solutions. The results offer a scalable, data-driven model for improving patient safety and operational performance in complex healthcare systems.
What Will You Learn
To help you get the most value from this session, we’ve highlighted a few key points. These takeaways capture the main ideas and practical insights from the presentation, making it easier for you to review, reflect, and apply what you’ve learned.
You’ll see how TOC’s Five Focusing Steps uncover the system bottlenecks that lead to most patient falls — shifting the focus from isolated interventions to high-leverage system constraints that block safer care.
The session reveals that fall reduction isn’t about willpower or reminders alone, but about building a reliable process with visible signals and aligned roles so that risk triggers aren’t missed before harm occurs.
It hints that by combining constraints management with data-driven problem identification and change management, hospitals can achieve scalable, sustainable improvements in safety — not just temporary declines in fall rates.
Instructor(s)
Bahadir Inozu, Ph.D
Dr. Baha Inozu is the cofounder and CEO of Sharp Focus, Inc., and a faculty member at the University of Southern California. He has collaborated with more than forty organizations to improve performance and reliability across a range of sectors. Internationally recognized for his expertise in system reliability and performance improvement, Dr. Inozu specializes in integrating leading methodologies to achieve high-impact outcomes. He currently supports the SafeMTS project as a Subject Matter Expert and contributes to the Shipyard Infrastructure Optimization Program (SIOP) for the U.S. Navy.
His research centers on identifying and applying best practices from high-risk industries to advance safety and reliability. He is the co-author of High Reliability for a Highly Unreliable World. Previously, he served as CEO of NOVACES and as Chairman of the School of Naval Architecture and Marine Engineering at the University of New Orleans.
Muhammed Atak
Dr. Muhammed Atak is a physician, public health expert, and currently serves as the Director General of Health Promotion at the Ministry of Health of Türkiye. He is also an associate professor at Istanbul University, Faculty of Medicine, where he teaches medical students, conducts research, and served as Deputy Chief Physician until August 2024. In his role as deputy chief physician, he was responsible for the oversight of clinical service delivery, infection control, laboratory operations, quality management, patient rights, and public relations units. His main professional interests include global health, health policy, humanitarian aid, and school health.
Dr. Atak graduated from Istanbul University, Faculty of Medicine in 2012 and completed his PhD in Public Health in 2021. He also earned a degree in Public Administration from Anadolu University and an associate degree in Disaster and Emergency Management. Throughout his career, he has held various administrative roles including district health director, deputy provincial health director, and unit head for healthcare supervision in Istanbul. He played a key role in managing health projects in underserved communities, organizing large-scale public health campaigns, and coordinating pandemic response operations such as mass vaccination and contact tracing.